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Peer-reviewedCC BYCase reports in ophthalmological medicine

Classic and Atypical Presentations of Nocardia Keratitis: A Two-Case Report Highlighting Diagnostic Challenges.

  • Mehrnaz Atighehchian1,2
  • Zohreh Abedinifar3
  • Alireza Latifi4
  • Roya Jafari1
  • Maryam Kasiri1
  • Ahmad Saberghadim1
4 affiliations
  1. 1Farabi Eye Hospital Tehran University of Medical Sciences Tehran Iran tums.ac.ir.
  2. 2Department of Ophthalmology TeMS.C. Islamic Azad University Tehran Iran tiau.ac.ir.
  3. 3Microbiology Unit Department of Pathology Tehran University of Medical Sciences Farabi Eye Hospital Tehran Iran tums.ac.ir.
  4. 4Department of Medical Parasitology and Mycology School of Public Health Tehran University of Medical Sciences Tehran Iran tums.ac.ir.
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Abstract

Nocardia keratitis (NK) is an uncommon infectious keratitis that may present with characteristic or atypical corneal morphology. We report two patients with contrasting clinical appearances and diagnostic courses, highlighting the differing contribution of in vivo confocal microscopy (IVCM) and microbiological testing. A 19-year-old male farmer presented after suspected dust exposure with multiple superficial pinhead infiltrates arranged in a wreath-like pattern. Gram staining showed Gram-positive branching bacilli, and high-quality IVCM demonstrated fine hyperreflective branching structures at the ulcer margin. A 37-year-old male welder presented after ocular trauma with a sharply demarcated paracentral infiltrate. Initial Gram staining was negative, and an IVCM examination performed at a different site was technically limited and non-diagnostic; however, culture on chocolate agar grew Nocardia species after 3 days, and modified acid-fast staining confirmed partially acid-fast branching filaments. Both patients were diagnosed with NK and improved with amikacin-based topical therapy and sulfacetamide. These cases show that NK may have classic or atypical morphology and that a technically limited or inconclusive IVCM examination does not exclude the diagnosis. Corneal scraping, appropriate staining, and culture remain essential when NK is clinically possible.

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Cite

BibTeXRIS
BibTeX
@article{atighehchian2026classic,
  title = {{Classic and Atypical Presentations of Nocardia Keratitis: A Two-Case Report Highlighting Diagnostic Challenges.}},
  author = {Mehrnaz Atighehchian and Zohreh Abedinifar and Alireza Latifi and Roya Jafari and Maryam Kasiri and Ahmad Saberghadim},
  journal = {Case reports in ophthalmological medicine},
  year = {2026},
  month = oct,
  doi = {10.1155/crop/1502013},
  url = {https://europepmc.org/article/MED/42910332},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Classic and Atypical Presentations of Nocardia Keratitis: A Two-Case Report Highlighting Diagnostic Challenges.
AU  - Mehrnaz Atighehchian
AU  - Zohreh Abedinifar
AU  - Alireza Latifi
AU  - Roya Jafari
AU  - Maryam Kasiri
AU  - Ahmad Saberghadim
PY  - 2026
DA  - 2026/10/21
JO  - Case reports in ophthalmological medicine
DO  - 10.1155/crop/1502013
UR  - https://europepmc.org/article/MED/42910332
AB  - Nocardia keratitis (NK) is an uncommon infectious keratitis that may present with characteristic or atypical corneal morphology. We report two patients with contrasting clinical appearances and diagnostic courses, highlighting the differing contribution of in vivo confocal microscopy (IVCM) and microbiological testing. A 19-year-old male farmer presented after suspected dust exposure with multiple superficial pinhead infiltrates arranged in a wreath-like pattern. Gram staining showed Gram-positive branching bacilli, and high-quality IVCM demonstrated fine hyperreflective branching structures at the ulcer margin. A 37-year-old male welder presented after ocular trauma with a sharply demarcated paracentral infiltrate. Initial Gram staining was negative, and an IVCM examination performed at a different site was technically limited and non-diagnostic; however, culture on chocolate agar grew Nocardia species after 3 days, and modified acid-fast staining confirmed partially acid-fast branching filaments. Both patients were diagnosed with NK and improved with amikacin-based topical therapy and sulfacetamide. These cases show that NK may have classic or atypical morphology and that a technically limited or inconclusive IVCM examination does not exclude the diagnosis. Corneal scraping, appropriate staining, and culture remain essential when NK is clinically possible.
SN  - 2090-6722
SN  - 2090-6730
ER  -